Does Meritain Health Cover Drug and Alcohol Rehab? - Treatment Solutions

Does Meritain Health Cover Drug and Alcohol Rehab?

Meritain Health covered Addiction Treatment

Meritain Health provides health insurance coverage for addiction (substance use disorder) treatment. If Meritain Health is your insurance provider, you may receive partial or full coverage for most substance use disorder treatments. Coverage varies based on your particular plan.

Founded in 1983, Meritain Health offers health benefits to over 1.5 million members across the United States.1,2 As a subsidiary of Aetna and CVS, Meritain boasts access to over 690,000 healthcare providers nationwide.2

Most rehab centers can check your Meritain Health insurance coverage for drug and alcohol addiction for you. Call the centers you are interested in and the admissions navigator will check your coverage for you while you’re on the phone. If you prefer, you can call the number on the back of your insurance card to speak with a Meritan Health customer service agent who can help you learn more about what is covered for drug and alcohol addiction treatment under your plan.

What will Meritain Health cover?

Meritain Health covers a variety of addiction treatments and services. The level and type of coverage vary depending on your specific plan. Substance use disorders are typically treated using a combination of evidence-based therapy services and detoxification. Treatment options that may be covered by your Meritain plan include:3

  • Inpatient/residential rehab: Inpatient rehab programs require you to live at the facility for the duration of treatment. Services may include behavioral therapies, detox, and 24/7 access to medical staff who are there to help and support you through your journey to sobriety. Meritain health may limit the number of days you can attend inpatient rehab to a set number of days per calendar year.
  • Partial hospitalization programs (PHP): PHP are day treatment programs that have you attending up to 8 hours a day for up to 5 days a week at a treatment center. PHP is generally less intensive than inpatient treatment centers, but still requires a time commitment and offers similar therapies and supports.
  • Intensive Outpatient Programs (IOP). IOP programs typically include individual and group therapy, family therapy, and support group meetings. Most require you to attend up to 4 hours a day approximately 3 days a week.
  • Outpatient rehab. Outpatient treatment programs allow you to live at home and attend to work and family responsibilities throughout the day, and attend the treatment program in the evenings or a set number of hours 1 day a week, depending on the program. Meritain Health may limit the number of days members can attend to a set number of days per year.

Before you begin treatment, you will meet with an admissions navigator or medical staff to be assessed and determine the appropriate level of care you need. They will recommend a treatment program for you based on your addiction history, substances used, your age, and other factors (e.g., if you have another mental health disorder diagnosis).

Meritain Health may cover all or some of your costs of addiction treatment. The level of coverage will vary, based on your specific plan. Many treatment centers will check your insurance benefits for you over the phone so you can know ahead of time which treatments are covered and how much you will be expected to pay out-of-pocket.

Does Meritain Health Cover Mental Health Care?

Many persons who struggle with drug and alcohol addiction also have a mental health disorder diagnosis, such as anxiety, depression, post-traumatic stress disorder (PTSD), and mood disorders, among others. This is known as a co-occurring disorder/dual diagnosis. More than 8 million adults (ages 18 and older) had both substance use disorder and a mental health condition, according to the 2016 National Survey on Drug Use and Health.4

Dual diagnoses often impact one another, and treating both at the same time is associated with more positive outcomes.5 Most rehab centers treat mental health conditions along with addiction to provide you with a better foundation of healing and support your ongoing sobriety.

Under the Affordable Care Act (ACA), insurance providers are required to provide coverage for mental health care & substance use disorder treatment.6 Meritain Health provides both physical and behavioral health services for its members. Many Meritain Health plans cover mental health treatment while in addiction treatment to ensure improved quality of life and outcomes.7

How Long Does Meritain Health Cover Inpatient Drug Rehab program?

Meritain Health offers a number of different policies and levels of coverage. The length of time covered for drug and alcohol treatment may vary depending on your specific plan. Most Meritain Health plans will provide coverage for a certain number of days in a calendar year for inpatient and outpatient rehab treatment services.

Longer treatment times are considered to be most effective when it comes to positive treatment outcomes. Generally, longer stays in rehab are associated with better outcomes, including fewer instances of relapse and improved rates of long-term sobriety. 8

Log in to the Meritain Health member portal to learn more about what your plan covers for drug and alcohol addiction treatment. Or call the number on the back of your insurance card to speak with a Meritain Health customer service representative, who can go over the details with you about what is covered and how many days you can attend treatment with insurance coverage.

What if my Meritain Health policy does not cover Inpatient Drug rehab program?

As a Meritain Health member, at least some of your treatment should be covered by your insurance plan. Even if your insurance policy does not cover all of your rehab expenses, it’s important to enter treatment as soon as you’re ready. Getting and completing treatment saves lives, and will help give you the treatment and tools to get on the road to recovery and live a sober life.

Many drug and alcohol treatment centers throughout the United States work with Meritain Health to provide coverage for drug and alcohol addiction. Even if you will have some out-of-pocket expenses for treatment, don’t let that hold you back from getting the help you need. There are a number of financial options to help you pay for treatment, including:

  • Asking family and friends for support.
  • Payment plans offered by rehab centers allow you to pay back your out-of-pocket costs over time.
  • Scholarships and grants are offered by rehab centers and the government at the state and federal level.

Admissions navigators at the rehab center can discuss your payment options with you. They will verify your insurance for you on the phone so you can have an idea of what your financial out-of-pocket expenses will be (e.g., deductibles, copays). They can also help you formulate a plan to cover any of the expenses you are responsible for covering out-of-pocket.

Meritain Health In-Network vs. Out of Network Drug Rehab Centers

Rehab facilities that are in-network with Meritain Health offer treatment for members at a negotiated, lower rate than other rehab centers. This is because these facilities have an agreement with Meritain Health. Out-of-network facilities do not have an agreement with Meritain Health to offer services at a discounted rate, and are generally more expensive than in-network rehab centers.

When you choose an out-of-network facility, this generally means you will be responsible for paying more of the expenses yourself. The expenses can add up quickly. The difference in selecting an in-network vs. out-of-network rehab facility can be significant.

Meritain Health is accepted at a number of excellent, high-quality rehab facilities throughout the United States, so work with an in-network facility if you can. When you seek rehab services, you have access to Aetna’s broad national provider network of approved facilities in-network. This is because Meritain is a subsidiary of Aetna. Aetna’s network contains more than 850,000 participating physicians and ancillary providers, with 6,900 hospitals.9 Selecting an in-network treatment facility will help you save money and let you focus on what matters most: your recovery and sobriety.

In some cases, Meritain Health may cover some of the costs for treatment at out-of-network treatment facilities. However, this generally requires pre-authorization and demonstration that you need to attend the out-of-network facility. In most cases, this may require more legwork on your end, including paperwork to get insurance approval.

Check Meritain Health Coverage for Alcohol and Drug Addiction Treatment

It’s important to check your Meritain Health insurance benefits before you make your final decision about which rehab facility you plan to attend. This can help you understand what is covered, and what expenses will be out-of-pocket for addiction treatment. There are a few ways to learn more about your insurance coverage:

  • Call the number on the back of your insurance card. This will connect you with a Meritain Health customer service representative who can go over the details of your specific plan with you
  • Login to Meritain Health’s member portal
  • Call American Addiction Centers on our helpline: to speak to an admissions navigator who would be happy to check your benefits for you while you’re on the phone.